Marital conflict of a nurse family following COVID-19 vaccinations: A case studying.

Vaccination is one of the best strategies to control a pandemic. Although there is much research evidence of its effectiveness, a small percentage of people would not incubate the vaccine. After starting vaccination of healthcare workers as the first group in Iran, there were many debates and concerns regarding the effectiveness of the COVID-19 vaccine and its long-term side effects among them. In this investigation, the impact of these disagreements on the relationship of a nurse couple has been presented. The wife believed that people should incubate the COVID-19 vaccine as soon as possible and the man was anti-vaxxer and he believed that COVID-19 vaccines are not safe and it should be refused. After that, the wife got the COVID-19 vaccine, and their difference in views led to marital conflicts and disturbance in the function of the family. This case study was approved by the Research Council and Ethics Committee of Semnan University of Medical Science. Vaccine refusing could have complicated effects on a community and family. There should be a plan to assess families' function and apply it in the case of disturbance in families' function. Moreover, several strategies should be implemented to persuade anti-vaxxers.

A Longitudinal Study of Hospital Safety From Disasters in Kermanshah Province, Iran: Insights for Disaster Risk Reduction.

OBJECTIVE: The Hospital Safety Index (HSI) developed by the World Health Organization (WHO) was adopted by most countries to evaluate the safety of hospitals against disasters. This study aimed to assess the status of hospital safety from disasters between 2016 and 2022 in Kermanshah province in Iran. METHODS: This is a retrospective longitudinal study which investigated HSI data from 23 hospitals. Data were gathered by Farsi Hospital Safety Index (FHSI) and analyzed with a repeated measures analysis of variance (ANOVA). RESULTS: The risk of hydro-meteorological (from 43.1 to 32.7) and biological hazards (51.3 to 35.5) significantly decreased. Although structural safety remained constant (from 67.8 to 70.1), nonstructural (from 51.5 to 71.2), and functional (from 47.1 to 71.2) safety scores increased significantly over study period. CONCLUSIONS: The findings revealed hospitals safety in Kermanshah province gradually improved. However, the health-care stakeholders should pay the necessary attention to improving the structural safety of hospitals.

Emergency care utilization and patients' outcome before and after COVID-19 national lockdown in Iran: a cross-sectional study.

INTRODUCTION: COVID-19 rapidly spread throughout the world. Stay-at-home and social distance strategies accompanied by fear of contamination with COVID-19 caused significant disruptions in daily life. The study focused on the impact of the COVID-19 pandemic on emergency visit and patients' outcome in the emergency department (ED). METHOD: Administrative and clinical data of 25-hospital EDs in Kermanshah province of Iran from February 20, 2020, to February 18, 2021, were retrospectively analyzed with the comparable periods in the previous year. The incidence rate ratio (IRR) was used to compare the differences between the pandemic and the pre-pandemic period. RESULT: The number of ED visits decreased nearly 50% after the declaration of a national lockdown. Moreover, the proportion of patients triaged in ESI 1 and 2 levels increased by 40 and 52%, respectively. The ratio of patients admitted to intensive care units and discharged against medical advice also increased significantly. CONCLUSION: Despite the number of ED visits sharply declining, the ratio of patients who came to EDs with higher acuity significantly increased. So, health authorities must sensitize the public about life-threatening signs and symptoms in such conditions.

Challenges of and corrective recommendations for healthcare-associated infection's case findings and reporting from local to national level in Iran: a qualitative study.

BACKGROUND: The accuracy of health care-associated infections (HAIs) statistics in many countries is questionable and the main reasons of this inaccuracy are not well-known. The study aim was to explore inhibitors of and corrective recommendations for HAIs case findings and reporting in some of Iran hospitals. METHODS: Sixteen face-to-face interviews and an expert panel were performed with expertise of infection prevention and control (IPC) programs in hospitals, and Deputies of Health and Treatment in medical university and Ministry of Health from Feb 2018 to May 2019. Using conventional content analysis, code, subcategories and categories were developed. RESULT: Three categories emerged including improper structure preparation, conflict of interest, and inadequate motivation. Allocating distinct budget and adequate staff to IPC programs, developing a user-friendly surveillance system and engaging physicians and nurses for HAIs reporting are the main corrective recommendations accepted by the expert panel. CONCLUSION: Despite the improvement in growing case-findings and reporting of HAIs in Iran, there are many challenges which inhibit accurate case finding and reporting of HAIs. So it is necessary to update the structure, system and rules to reach accurate HAIs data in Iran.

Fair prioritization of casualties in disaster triage: a qualitative study.

BACKGROUND: Disasters may result in mass casualties and an imbalance between health care demands and supplies. This imbalance necessitates the prioritization of the victims based on the severity of their condition. Contributing factors and their effect on decision-making is a challenging issue in disaster triage. The present study seeks to address criteria for ethical decision-making in the prioritization of patients in disaster triage. METHODS: This conventional content analysis study was conducted in 2017. Subjects were selected from among Iranian experts using purposeful and snowball sampling methods. Data were collected using semi-structured interviews and were analyzed by the content analysis. RESULTS: Efficient and effective triage and priority-oriented triage were the main categories. These categories summarized a number of medical and nonmedical factors that should be considered in the prioritization of the victims in disaster triage. CONCLUSION: A combination of measures should be considered to maximize the benefits of the prioritization of causalities in disasters. None of these measures alone would suffice to explain all aspects of ethical decision-making in disaster triage. Further investigations are needed to elaborate on these criteria in decision-making.

Perceptions on principle of priority setting in disaster triage: A Q-method study.

INTRODUCTION: An ethical plan is required to make decisions regarding setting the priority for assisting injured patients through triage. The aim of this study was to explore the measures used to sort patients for ethical decision-making in disaster triage. METHOD: The participants were 54 clinicians and non-clinicians among the Iranian experts. Q-statements were selected from a literature review and face-to-face interviews. Data were analyzed by principal components factor analysis (PCA), Varimax, and hand-rotation techniques. RESULTS: Distinct perspectives included: Saving patients with greater medical needs, survivability of patients and the community, providing effective treatment based on available capacity, maximizing health gain, supporting the human generation and productive and independent lives. Approximately 61% of the variance in decision is explained by these factors. CONCLUSION: A combination of saving more people and more positive outcomes has been accepted to make an ethical decision in triage. Public engagement needs to reach a more acceptable view of patients' prioritizing factors in a scarce-resource situation.

Triage Training in Iran from 2010 to 2020: A Systematic Review on Educational Intervention Studies.

BACKGROUND: Accurate decision-making in triage requires continuous education, so triage nurses should receive annual refresher courses. Identifying the most effective method can make the provision of practical education to triage staff in hospitals possible. This review was conducted with the aim to determine the effectiveness of triage education methods in Iran. MATERIALS AND METHODS: In this systematic review on educational intervention studies, international and Iranian medical sciences databases were searched using a defined search strategy compatible with each database. PubMed, Scopus, Web of Science, Google Scholar, SID, Islamic Science Center (ISC), and IranDoc databases were searched for literature published from January 2010 to January 2020. The MeSH terms of "health care staff," "triage," "education," and "Iran" in English and Persian were combined to develop a search strategy. Initially, 768 article titles were retrieved. Finally, 16 articles were selected for the review. RESULTS: All conducted studies were quasi-experimental. Half of the studies had used a face-to-face approach for education (workshop, lecture, and simulation), and four studies had used lectures and pamphlets. All studies (except 1) reported that their educational intervention significantly improved nursing knowledge on triage. CONCLUSIONS: Almost all studies had reported the effectiveness of an educational intervention in improving nurses' triage knowledge. However, it seems that the non-face-to-face method is superior to the face-to-face method because of its learner-centeredness and cost-effectiveness. Moreover, providing educational content using a blended learning approach (simulation and games) can enhance the effectiveness of triage education.

Improving the storage stability of tomato paste by the addition of encapsulated olive leaf phenolics and experimental growth modeling of A. flavus.

It is necessary to apply some preservatives for tomato paste since in the harvest season, a high load of tomatoes need to be processed as they are among highly perishable products. Application of antimicrobial extracts or essential oils, as natural preservatives, in their raw forms might reduce their efficiency when they are exposed to environmental conditions. However, microencapsulation is a well-known method to solve this problem. Our main goal was to restrict fungal growth rate in stored tomato paste and increase its storage stability by incorporating encapsulated olive leaf phenolic-rich extract. Total Soluble Solids (TSS), consistency, pH, color indices and diametrical growth rate of Aspergillus flavus were measured for different samples. The treatments designed in terms of considering two levels of non-encapsulated olive phenolics extract with 500 and 1000 ppm (NE500 and NE1000), the same levels with encapsulated extract; i.e., 500 and 1000 ppm (ME500 and ME1000), and similar levels of the common preservative of sodium benzoate with 500 and 1000 ppm (B500 and B1000). Antifungal properties of NE samples were higher than ME ones during storage although ME samples could maintain diametrical growth rate of the fungus more stable than NE ones. NE samples justified lower maximum growth rate than ME samples while ME samples could extend lag phase of microbial growth compared with NE one and delay their internal deteriorative reactions. Among Baranyi, modified Baranyi, Modified Gompertz, and Logistic models, Modified Gompertz model represented the best model and could fit the growth factors of A. flavus on tomato paste with higher R2 index as well as lower RMSE and SSE indices. Based on the results obtained, it could be concluded that usage of encapsulated olive leaf extract in tomato paste is an effective, natural and sustainable approach to improve the shelf life of tomato paste since this natural compound could perform as favourable as preservatives; also it could maintain physicochemical as well as microbial properties of tomato paste for a long term. Thus, it is strongly recommended that application of encapsulated olive leaf extract to be considered seriously by the tomato paste industry as it can effectively reduce the mold and fungal contaminations which are very common and prevalent in the plants. The future work in this regard should focus on sensory evaluations when incorporating encapsulated olive leaf extract into tomato paste.

Evidence-Based Practice for Cardiac Intensive Care Unit Nurses: An Educational Intervention Study.

BACKGROUND: This study examined the effectiveness of two educational methods on nurses' skills and commitment to implementing evidence-based practice (EBP). METHOD: Ninety nurses were randomly assigned to three groups. Participants in the workshop group took part in a 2-day training course, participants in the multimedia group received educational content through video, and participants in the control group did not receive any training content. The nurses' skills and commitment to implement EBP were assessed at baseline and 1 month after the teaching sessions. RESULTS: The EBP skills of nurses in the intervention groups were significantly enhanced compared with nurses in the control group (p < .05). Mean scores in the multimedia group were slightly better than in the workshop group; however, this difference was not statistically significant. Commitment to EBP implementation did not change significantly over time among the groups (p > .05). CONCLUSION: Different methods of training can be useful in improving nurses' EBP skills; however, the participants' commitment to implement EBP did not change considerably. Because of its cost effectiveness, the multimedia method should be considered for use in nurse training. [J Contin Educ Nurs. 2020;51(4):167-173.].

Emergency numbers accessibility for disabled peoples': Case of the Islamic Republic of Iran.

INTRODUCTION: An emergency is a serious, unexpected situation which may lead to injury, loss of life and damage to property and often needs urgent interventions. Emergency calls can bring urgent life-saving intervention in such situations. Although access to emergency lines for all persons of a society is one of the effectiveness indexes of this critical service, in most countries, these lines are not accessible for disabled people. CASE PRESENTATION: This study examined the issue of emergency number accessibility for disabled people in the I.R. of Iran. Two persons who had been poisoned by carbon monoxide died because their deaf-mute father could not communicate with the Emergency Medical Service Center (EMSC). This led to the Emergency Medical Service Management Center (EMSMC), in collaboration with Iranian Society of Deaf People Family (ISDPF), developing a system that is a combination of short message system (SMS) and location-based information (LBI) to facilitate the communication of such disabled persons with EMSMCs. The system did not receive any emergency message until this report is provided. CONCLUSION: Because emergency call service has not been available for disabled people in Iran until now, emergency service organizations should take a proactive approach in developing a reliable and easy to use a method with the current technologies. These organizations should also provide information about the installed systems for end-users.

Health care-associated infection surveillance system in Iran: Reporting and accuracy.

BACKGROUND: Valid data are a crucial aspect of infection prevention and control programs. The aim of this study was to examine the accuracy of routine reporting in the Iranian Nosocomial Infection Surveillance System in intensive care units. METHODS: A blinded retrospective review of general intensive care unit medical records was performed with a standard case-finding form. Infection control nurses (ICNs) were also interviewed to explore possible reasons for differences. RESULTS: The results of 951 events in 856 medical records were assessed. Sensitivity, specificity, and positive and negative predictive values of routine surveillance were 27.5%, 97.2%, 69%, and 85.3%, respectively. The results indicate 82.2%, 68.4%, 62.7%, and 57.3% under-reporting of surgical site infections, urinary tract infections, bloodstream infections, and pneumonia, respectively. Over-reporting of approximately 8%-15% was detected in 4 types of health care-associated infections (HAIs). Misinterpretation of HAI definition, high ICN workload, and inactivity of infection control link nurses were the main causes of inaccurate reporting. CONCLUSIONS: Under and over-reporting of HAIs are main challenges of HAIs reporting in Iran. Developing guidelines, empowering ICNs through specialized training and activating infection control link nurses are necessary to achieve more accurate data in the Iranian Nosocomial Infection Surveillance System.

Ethical prioritization of patients during disaster triage: A systematic review of current evidence.

INTRODUCTION: Triage is a dynamic and complex decision-making process in order to determine priority of access to medical care in a disaster situation. The elements which should govern an ethical decision-making in prioritizing of victims have been debated for a long time. This paper aims to identify ethical principles guiding patient prioritization during disaster triage. METHOD: Electronic databases were searched via structured search strategy from 1990 until July 2017. The studies investigating patients' prioritization in disaster situation were eligible for inclusion. All types of articles and guidelines were included. RESULT: Of 7167 titles identified in the search, 35 studies were included. The important factors identified in patient prioritization were grouped into two categories: medical measures (medical need, likelihood of benefit and survivability) and Nonmedical measures (saving the most lives, youngest first, preserving function of society, protecting vulnerable groups, required resources and unbiased selection). Demographic characteristics, health status of patients, social value of patient, and unbiased selection are discriminatory factors in disaster triage. CONCLUSION: Various factors have been introduced to consider ethical patient prioritization in disaster triage. Providers' engagement, public education, and ongoing training are required to reach a fair decision.

Arrhenius equation modeling for the shelf life prediction of tomato paste containing a natural preservative.

BACKGROUND: The shelf life of tomato paste with microencapsulated olive leaf extract was compared with that of samples containing a commercial preservative by accelerated shelf life testing. Based on previous studies showing that olive leaf extract as a rich source of phenolic compounds can have antimicrobial properties, application of its encapsulated form to improve the storage stability of tomato paste is proposed here. RESULTS: Regarding total soluble solids, the control and the sample containing 1000 µg g-1 sodium benzoate had the lowest (Q10 = 1.63) and highest (Q10 = 1.88) sensitivity to temperature changes respectively; also, the microencapsulated sample containing 1000 µg g-1 encapsulated olive leaf extract (Q10 = 1.83) followed the sample containing 1000 µg g-1 sodium benzoate in terms of the highest kinetic rates. In the case of consistency, the lowest and highest activation energies (Ea ) corresponded to samples containing 1000 µg g-1 non-encapsulated olive leaf extract and 1000 µg g-1 microencapsulated olive leaf extract respectively. CONCLUSION: Interestingly, samples containing microencapsulated olive leaf extract could maintain the original quality of the tomato paste very well, while those with non-encapsulated olive leaf extract rated the worst performance (among all specimens) in terms of maintaining their quality indices for a long time period. Overall, the shelf life equation was able to predict the consistency index of all tomato paste samples during long-time storage with high precision. © 2017 Society of Chemical Industry.